Provider Demographics
NPI:1508686312
Name:KENNIBREW, AMANI R
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:R
Last Name:KENNIBREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 E 155TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1917
Mailing Address - Country:US
Mailing Address - Phone:216-808-0748
Mailing Address - Fax:
Practice Address - Street 1:4088 E 155TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1917
Practice Address - Country:US
Practice Address - Phone:216-808-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker